MAJORITY REPORT. 
261 
MEDICAL INSTITUTIONS. 
640. While the Insurance Act contemplated that Medical 
Benefit should normally be provided by medical practitioners 
under contract with Insurance Committees, it provided for two 
possible deviations from the standard arrangements. In the first 
place it authorised Insurance Committees where they saw fit, 
to allow insured persons to make their own arrangements for 
receiving Medical Benefit, and where the circumstances were 
sufficiently exceptional to justify the adoption of this course a con- 
tribution was made towards defraying the cost of the Medical 
Benefit so obtained. The second exception related to medical 
institutions which had been providing medical attendance to the 
working classes in the past, and provision was made, safeguarding 
existing rights, whereby under certain conditions these institu- 
tions might be incorporated in the machinery for providing 
Medical Benefit. It is with the second of these exceptions that 
we are here concerned. 
641. Under Section 15 (4) of the 1911 Act such systems or 
institutions for the provision of medical attendance and treat- 
ment, as were in existence at the date of the passing 
of the Act, might be approved by an Insurance Committee 
and the Department for the purpose of providing Medical 
Benefit. Insured persons who were members of these 
approved institutions might then receive their medical benefit 
through the institution, the actual cost of the treatment, or 
the capitation fees in respect of members so treated, whichever 
is the less, being paid to the institution out of insurance funds. 
The majority of these institutions are bodies which were formed by 
associations of the Friendly Societies for the purpose of provid- 
ing medical attention and treatment to their members prior to 
the passing of the 1911 Act. 
642. We are informed (Brock and Smith Whitaker, Q. 24,009- 
24,012; British Medical Association, Q. 15,222) that the 
treatment given to members of these institutions is as 
a rule inferior in quality to that provided under the 
normal panel arrangements, and we are also given to 
understand (British Medical Association, Q. 15,221; Brock, 
Q. 24,009) that administration and control by lay committees 
has proved in many cases to be ineffective. ~ Any disciplinary 
action taken by Insurance Committees following upon complaints 
made by members of the Institutions cannot be brought to bear 
directly on the individual doctors responsible as these are the 
servants of the institutions. The Minister has power to with- 
draw approval in any case in which he is not satisfied that an 
Institution is conducted in such a manner as to comply with 
the terms of service of insurance doctors, but this would not 
be an appropriate penalty in cases of complaint by an insured